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Prenatal diagnosis and treatment planning of congenital heart defects—possibilities and limits

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Abstract

Background

Newborns with hypoplastic left heart syndrome (HLHS) or right heart syndrome or other malformations with a single ventricle physiology and associated hypoplasia of the great arteries continue to be a challenge in terms of survival. The vast majority of these forms of congenital heart defects relate to abnormal morphogenesis during early intrauterine development and can be diagnosed accurately by fetal echocardiography. Early knowledge of these conditions not only permits a better understanding of the progression of these malformations but encourages some researchers to explore new minimally invasive therapeutic options with a view to early pre- and postnatal cardiac palliation.

Data sources

PubMed database was searched with terms of “congenital heart defects”, “fetal echocardiography” and “neonatal cardiac surgery”.

Results

At present, early prenatal detection has been applied for monitoring pregnancy to avoid intrauterine cardiac decompensation. In principle, the majority of congenital heart defects can be diagnosed by prenatal echocardiography and the detection rate is 85%–95% at tertiary perinatal centers. The majority, particularly of complex congenital lesions, show a steadily progressive course including subsequent secondary phenomena such as arrhythmias or myocardial insufficiency. So prenatal treatment of an abnormal fetus is an area of perinatal medicine that is undergoing a very dynamic development. Early postnatal treatment is established for some time, and prenatal intervention or palliation is at its best experimental stage in individual cases.

Conclusion

The upcoming expansion of fetal cardiac intervention to ameliorate critically progressive fetal lesions intensifies the need to address issues about the adequacy of technological assessment and patient selection as well as the morbidity of those who undergo these procedures.

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Author information

Authors and Affiliations

  1. Division of Neonatology, University Hospital Berne, Berne, Switzerland

    Mathias Nelle

  2. Division of Pediatric Cardiology, University Hospital Berne, Berne, Switzerland

    Mladen Pavlovic

  3. Department of Cardiac Surgery, University Hospital Berne, Berne, Switzerland

    Thierry Carrel

  4. Department of Obstetrics and Gynecology, University Hospital Berne, Berne, Switzerland

    Luigi Raio, Daniel Surbek & Matthias Meyer-Wittkopf

Authors
  1. Mathias Nelle
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  2. Luigi Raio
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  3. Mladen Pavlovic
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  4. Thierry Carrel
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  5. Daniel Surbek
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  6. Matthias Meyer-Wittkopf
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Correspondence to Mathias Nelle.

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Nelle, M., Raio, L., Pavlovic, M. et al. Prenatal diagnosis and treatment planning of congenital heart defects—possibilities and limits. World J Pediatr 5, 18–22 (2009). https://doi.org/10.1007/s12519-009-0003-8

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  • DOI: https://doi.org/10.1007/s12519-009-0003-8

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